Colon and Rectal Cancer

Transcription

1 Colon and Rectal Cancer Figure 6 Definition: Cancers that form in the tissues of the colon (longest part of the large intestine), or cancers that form in the tissues of the rectum (the last several inches of the large intestine closest to the anus). 1 Background: From 2002 to 2006, there was a yearly average of approximately 6,442 newly diagnosed cases of colorectal cancer in Ohio. 2 During this same time period, Ohio experienced approximately 2,479 deaths each year due to colorectal cancer. 2 In Ohio, colorectal cancer is the third most common cancer diagnosed, and it is the second most common cause of cancer-related deaths for both genders combined. 3 The mortality rate has declined 20 to 25 percent in Ohio over the past two decades. 3 Mortality rates have dropped from 32.9 per 100,000 in 1970 to 20 per 100,000 in The decline in mortality rates is attributed to increased use of colorectal screening, dietary changes, and use of aspirin. 3 Cuyahoga County Data: The average annual number of newly diagnosed colorectal cancer cases from was 831, with an ageadjusted incidence rate of 51.1 per 100,000 people. This is lower than the 52.1 incidence rate for Ohio and higher than the 49.1 incidence rate for the Nation. The average annual number of colorectal cancer deaths from was 328, with an age-adjusted mortality rate of 19.7 per 100,000 people. This is lower than the 20.0 mortality rate for Ohio and higher than the 18.2 mortality rate for the Nation. Table 6a Colon and Rectal Cancer Average Annual Number of Cancer Cases and Age-Adjusted Incidence Rates* for Incidence Male Female Total Cases Rate Cases Rate Cases Rate Cuyahoga County Ohio 3, , , National SEER * Rate is calculated per 100,000 people. Table 6b Colon and Rectal Cancer Average Annual Number of Cancer Deaths and Age-Adjusted Mortality Rates* for Mortality Male Female Total Cases Rate Cases Rate Cases Rate Cuyahoga County Ohio 1, , , National SEER * Rate is calculated per 100,000 people Cuyahoga County Board of Health Cancer Report Colon Cancer Page 1 of 8

2 Figure 6a Figure 6b *Data were suppressed to help maintain confidentiality and /or due to concerns over unstable numbers. See methods/limitations section for additional details Cuyahoga County Board of Health Cancer Report Colon Cancer Page 2 of 8

3 Chart 6a Average Annual Age-Adjusted Incidence Rates for Colorectal Cancer by Race and Place from (per 100,000 people) White Males Black Males White Females Black Females White Total Black Total City of Cleveland First Ring Suburbs Outer Ring Suburbs Cuyahoga County Ohio National Chart 6b Average Annual Age-Adjusted Mortality Rates for Colorectal Cancer by Race and Place from (per 100,000 people) White Males Black Males White Females Black Females White Total Black Total City of Cleveland First Ring Suburbs Outer Ring Suburbs Cuyahoga County Ohio ( ) National Rates are statistically significantly higher when compared to Cuyahoga County. Rates are statistically significantly lower when compared to Cuyahoga County. Rates are not compared to Cuyahoga County when there are <20 cases total for due to instability Cuyahoga County Board of Health Cancer Report Colon Cancer Page 3 of 8

4 Risk Factors Males: In the United States, 1 in 19 males will develop colorectal cancer and 1 in 46 males will die from colorectal cancer. 4 Females: In the United States, 1 in 20 females will develop colorectal cancer and 1 in 50 females will die from colorectal cancer. 4 Several risk factors may contribute to the development of colorectal cancer. They include: 1 Age More than 90% of colorectal cancers occur in individuals 50 and older. Inflammatory bowel disease Personal or family history of colorectal cancer or colorectal polyps Inherited syndromes such as familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (Lynch syndrome), Turcot syndrome, and Peutz-Jeghers syndrome. Racial and ethnic background African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the U.S. Jews of Eastern European decent (Ashkenazi Jews) have one of the highest colorectal cancer risks in the world. Lack of regular physical activity Low fruit and vegetable dietary intake A low-fiber and high-fat diet Obesity Alcohol consumption Tobacco use Symptoms 1 Rectal bleeding or blood in or on the stool Change in bowel habits or stools that are narrower than usual Stomach discomfort (bloating, fullness or cramps) Diarrhea, constipation or feeling that the bowel does not empty completely Weight loss for no apparent reason Constant fatigue Screening, Prevention and Early Detection 1,5 Screening and Prevention: Increased use of colorectal cancer screening by sigmoidoscopy or colonoscopy has been suggested as the potential reason for declines in mortality rates from this cancer. 3 Screening can be used to prevent colorectal cancer or find and remove polyps that may eventually become colon cancer. 1 51% of Ohioans aged 50 and older reported having had a screening sigmoidoscopy or colonoscopy in the past 5 years. 3 The risk of colorectal cancer can be reduced by following screening guidelines, eating a healthy, low-fat high fiber diet, and increasing physical activity level Cuyahoga County Board of Health Cancer Report Colon Cancer Page 4 of 8

5 Adults aged 50 and older should be screened using one or multiple methods below: o Fecal Occult Blood Test annually o Sigmoidoscopy, every 3 years o Colonoscopy every 10 years starting at age 50, more frequently if polyps are detected, or with a family history of polyps or colon cancer. o Stool DNA test One of the Healthy People 2020 cancer goals is to increase the proportion of adults who receive a colorectal cancer screening to 70.5%. 6 The baseline for this goal was that 54.2% of adults age 50 to 75 years received a colorectal screening based on the most recent guidelines in 2008 (age adjusted to the 2000 standard population). 6 Staging Stage at Diagnosis describes the severity of a person s cancer and the extent to which it has or has not spread throughout the body. 7 Cancer staging is important in helping physicians plan appropriate treatment, as well as to estimate a patient s prognosis. 7 Cancer diagnosed in the in situ and localized stages are generally referred to as early-stage tumors, whereas regional and distant tumors are referred to as late-stage tumors. 2 Detecting cancers at an early stage may increase long-term survival and can lead to a reduction in mortality. 2 The National Cancer Institute groups staging into five main categories: 7 In situ: Abnormal cells are present only in the layer of cells in which they developed. In this report, in situ cases are only included for bladder cancer. Localized: Cancer is limited to the organ in which it began, without evidence of spread. Regional: Cancer has spread beyond the primary site to nearby lymph nodes or organs and tissues. Distant: Cancer has spread from the primary site to distant organs or distant lymph nodes. Unstaged/Unknown: There is not enough information to determine the stage. Chart 6c Stage at Diagnosis for Invasive Colon Cancer Diagnosed in Cuyahoga County from Distant 17% Unstaged 12% Localized 38% Regional 33% 2011 Cuyahoga County Board of Health Cancer Report Colon Cancer Page 5 of 8

6 Table 6c 5-year Relative Survival* by Stage at Diagnosis for Colorectal Cancer in the United States for , All Races, Both Sexes 8 5-year Stage at Diagnosis Relative Survival (%) Localized (confined to primary site) 90.4 Regional (spread to regional lymph nodes) 69.5 Distant (cancer has metastasized) 11.6 Unknown/Unstaged 38.3 *Relative survival compares observed survival for those with cancer to the expected survival for those without cancer. Figure 6c 2011 Cuyahoga County Board of Health Cancer Report Colon Cancer Page 6 of 8

7 Figure 6d *Data were suppressed to help maintain confidentiality and /or due to concerns over unstable numbers. See methods/limitations section for additional details. Chart 6d Average Annual Percentages of Colorectal Cancers by Stage of Diagnosis and Race for Cuyahoga County from White Early White Late White Unknown Black Early Black Late Black Unknown City of Cleveland First Ring Suburbs Outer Ring Suburbs Cuyahoga County Ohio 2011 Cuyahoga County Board of Health Cancer Report Colon Cancer Page 7 of 8

8 Chart 6e Average Annual Percentages of Colorectal Cancers by Stage of Diagnosis and Gender for Cuyahoga County from Male Early Male Late Male Unknown Female Early Female Late Female Unknown City of Cleveland First Ring Suburbs Outer Ring Suburbs Cuyahoga County Ohio *All races are included in staging calculations. * More Information National Cancer Institute American Cancer Society Ohio Department of Health Resources 1. The American Cancer Society. Colon Cancer Detailed Guide. (Accessed December 11, 2010). 2. Cancer Incidence and Mortality among Ohio Residents, Ohio Cancer Incidence Surveillance System, Ohio Department of Health and The Ohio State University, Columbus, Ohio, December The Ohio Department of Health. Colon and Rectum Cancer. (Accessed December 11, 2010). 4. The American Cancer Society. Lifetime Risk of Developing or Dying From Cancer. (Accessed January 10, 2011). 5. Case Comprehensive Cancer Center and Seidman Cancer Center Recommendations (February, 2011). 6. U.S. Department of Health and Human Services. Healthy People (Accessed February 24, 2011). 7. National Cancer Institute. Cancer Staging. (Accessed December 23, 2010). 8. Surveillance Epidemiology and End Results. SEER Stat Fact Sheets: Colon and Rectum. (Accessed December 11, 2010). 9. National Cancer Institute. What you need to know about cancer of the colon and rectum. Colorectal images from (Accessed December 11, 2010) Cuyahoga County Board of Health Cancer Report Colon Cancer Page 8 of 8